INTRODUCTION: Since December 2019, the novel coronavirus SARS-CoV-2 has been spreading worldwide . Since the main route of infection with SARS-CoV-2 is probably via contact with virus-containing droplets of the exhaled air, any method of securing the airway is of extremely high risk for the health care professionals involved . We evaluated the aerosol exposure to the interventional team during a tracheotomy in a semi-quantitative fashion . In addition, we present novel protective measures . MATERIALS AND
METHODS: To visualize the air movements occurring during a tracheotomy, we used a breathing simulator filled with artificial fog . Normal breathing and coughing were simulated under surgery . The speed of aerosol propagation and particle density in the direct visual field of the surgeon were evaluated .
RESULTS: Laminar air flow (LAF) in the OR reduced significantly the aerosol exposure during tracheostomy . Only 4.8â±â3.4% of the aerosol was in contact with the surgeon . Without LAF, however, the aerosol density in the inspiratory area of the surgeon is ten times higher (47.9â±â10.8%, pâ <â0.01). Coughing through the opened trachea exposed the surgeon within 400ms with 76.0â±â8.0% of the aerosol - independent of the function of the LAF . Only when a blocked tube was inserted into the airway, no aerosol leakage could be detected .
DISCUSSION: Coughing and expiration during a surgical tracheotomy expose the surgical team considerably to airway aerosols . This is potentially associated with an increased risk for employees being infected by airborne transmitted pathogens . Laminar airflow in an operating room leads to a significant reduction in the aerosol exposure of the surgeon and is therefore preferable to a bedside tracheotomy in terms of infection prevention . Ideal protection of medical staff is achieved when the procedure is performed under endotracheal intubation and muscle relaxation.